The Renewal of Generosity

August 22, 2005

Both doctors and patients are demoralized these days, says Arthur Frank, though neither group is aware of what the other is experiencing. Doctors are suffering discouragement and alienation instead of enjoying the hope and human connection that lured them to the profession. Patients feel like specimens and objects instead of human beings. It’s a familiar problem, to be sure, and it is also a paradigm for all of the transactions that occur between persons. We are all in need, and we all have something to give. Generosity, says Frank, is the missing currency.

As I read this book, I became increasingly aware that I occupy both positions in Frank’s dialectic on generosity. As a board-certified chaplain I stand among the ranks of health-care providers. In the larger society, however, my cerebral palsy places me with those who are systemically designated as receivers of care. Frank is right that the value of care is thought to flow from the top down. Frank’s notion that giving and receiving both require a honing of skills resonates with me.

Frank writes about his own illness, and he refuses to assume a position superior to that of his reader. Frank shares generously with the reader, and the natural response to generosity is more generosity.

The Renewal of Generosity reads like a cross between Plato’s Symposium and Jesus’ wedding feast for the poor and lame. There are dozens of voices at this motley dinner party, and although some of those present are designated as hosts and some as guests (Frank’s terms), everyone has something to say.

Frank harmonizes the work of Marcus Aurelius, Emmanuel Levinas and Mikhail Bakhtin. And he names this composite character the Dialogical Stoic. The primary term is stoic, which he wrests from its association with the puritanical asceticism of the West. Here the stoic is someone aware of life’s limitations and able to retain choice and personal power in the face of adversity.

The wrinkle is that no stoic is an island. Even stoics find themselves in relationships and conversations with others. The work of Levinas echoes loudly here. The other is profoundly other, and with a far greater significance than we are used to thinking about. Frank recruits Levinas and Bakhtin to teach us about the interdependence and independence that are essential for dialogue. And dialogue is to the philosopher what community is to the theologian.

Once the Dialogical Stoic is introduced, Frank takes pains to incorporate other voices. We meet those who suffer, those whom we might typically think of as people who need help. We do not experience their affliction firsthand, but Frank forces us to witness it, though he warns us often not to overidentify with those who suffer. We then meet caregivers, who have a very different experience of suffering. Caregivers must suffer the sufferers. It is a different burden, but no less real.

In this meditation on pain and our response to the pain of others, we begin to understand that dialogue is the medium between persons and that the link between communion and communication is more than linguistic.

This dialogical ethic becomes a larger principle of organization, even for Frank’s own literary technique. The book is written graciously and with an elaborate weave of narrative. It is the book you would want your doctor to read. Frank guides us through his case studies with care and gentleness. He is able to critique the violence of modern medicine without reproducing it anew.